Mood and Feelings Questionnaire: Parent

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Today's Date* This field is required.

Date

2

Child's Name * This field is required.

3

Child's Date of Birth* This field is required.

Date

4

Name of person filling the form:* This field is required.

6

TOTAL SCORE (Interpret the score using the table below):INTERPRETATION OF SCORES: 0-7: No Depression, 8-11: Mild Depression, 12 or higher: Significant depressive symptoms, suggesting the need for further evaluation.

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Total Score	Interpretation
0 - 7	No Depression
8 - 11	Mild Depression
12 or higher	Significant depressive symptoms, suggesting the need for further evaluation.

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DIRECTIONS: For each question, please select the option that best describes your child’s behavior over the past two weeks. If the statement does not apply to your child, select NOT TRUE. If the statement is only sometimes true, select SOMETIMES. If the statement is true most of the time, select TRUE.

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1. Felt miserable or unhappy.* This field is required.

Not True

Sometimes

True

10

2. Didn’t enjoy anything at all.* This field is required.

Not True

Sometimes

True

11

3. Felt so tired that she/he just sat around and did nothing.* This field is required.

Not True

Sometimes

True

12

4. Was very restless.* This field is required.

Not True

Sometimes

True

13

5. Felt she/he was no good anymore.* This field is required.

Not True

Sometimes

True

14

6. Cried a lot.* This field is required.

Not True

Sometimes

True

15

7. Found it hard to think properly or concentrate.* This field is required.

Not True

Sometimes

True

16

8. Hated herself/himself.

Not True

Sometimes

True

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9. Felt she/he was a bad person.

Not True

Sometimes

True

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10. Felt lonely.

Not True

Sometimes

True

19

11. Thought nobody really loved her/him.

Not True

Sometimes

True

20

12. Thought she/he could never be as good as other kids.

Not True

Sometimes

True

21

13. Felt she/he did everything wrong.

Not True

Sometimes

True